Provider Demographics
NPI:1235315599
Name:MULL, DEIRDRE ANN (PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:DEIRDRE
Middle Name:ANN
Last Name:MULL
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 PADDOCK COURT
Mailing Address - Street 2:
Mailing Address - City:RIDGELEY
Mailing Address - State:WV
Mailing Address - Zip Code:26753
Mailing Address - Country:US
Mailing Address - Phone:301-697-1156
Mailing Address - Fax:
Practice Address - Street 1:517 E OLDTOWN RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3687
Practice Address - Country:US
Practice Address - Phone:240-362-7077
Practice Address - Fax:240-362-7161
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR129899363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily